Rheumatology Flashcards
> 50 yoa, Unilateral temporal HA, swollen tender temp. artery, Jaw Claudication, fever, elevated ESR, weight loss. dx? tx? assoc?
Giant cell temporal arteritis via biopsy
assoc: polymyalgia rheumatica
tx: steroids
<40fever, elevated ESR, weight loss, w/absent pulses. how to dx? tx?
takayasu arteritis, dx w/angiongram.
tx: prednisone
What is polymyalgia rheumatica? whats it assoc w/?
Giant Cell Temporal arteritis. inflammatory disorder that causes muscle pain and stiffness, especially in the shoulders. worse in the morning. normal CK but elevated ESR.
Asian child, strawberry red tongue, truncal rash, palmer erythema, MI in kid. dx? tx?
Kawasaki
Tx: IVIG, ASA
Renal failure, mesenteric ischemia, purpura, painful nodules + Mononeuritis Multiplex. dx? tx? assoc?
PAN, assoc w/HEP B.
dx: angiogram
tx: steroids + cyclophos bc dz is so severe.
Mononeuritis Multiplex: motor +sensory deficits at periphery that come and go, painful + asymmetric
Pt w/hematuria, hemotysis + nasal problems. dx? assoc? tx?
Wegners = C-ANCA
dx: biopsy shows necrotizing granulomas
tx: steroids + cyclophos
Cryoglobinemia
assoc w/HEPC = palpable purpura + RF, elevated ESR + cryoglobins in serum along with decreased compliment
tx: steroids + Cyclophosphamide
Eosinophilic Polyangitis
dx? tx?
looks just like wegners w/PANCA & eosinophils on biopsy
tx: steroids + cyclo
Association ab dz: smith
lupus
Association ab dz: RF
RA
Association ab dz: CCP
RA
Association ab dz: Histone
drug induced lupus
Association ab dz: ds-DNA
lupus + renal
Association ab dz: mitochondrial
PBC
Association ab dz: JO
polymyositis
Association ab dz: Ro + La
Sjogren
Association ab dz: Topo(SCL70)
Systemic Scleroderma
Association ab dz: centromere
Scleroderma CREST
Association ab dz: smooth muscle
AI hepatitis
sx of lupus?
cerebritis(psycosis, ams), alopecia, malar/discoid rash, oral ulcers, libman-sacks endocarditis, arthralgias, renal failure, serositis(chest pain from lungs), 2nd trimester losses(hypercoagubility due to antiphospholipid syndrome)
Ab assoc w/ lupus nephritis?
ds-DNA ab
everyone with lupus gets….alternate?
Hydroxychloroquine > methotrexate
tx of lupus flares/mild?
steroids
tx of life threatening lupus nephritis or cerebritis?
IV cyclophosphamide then transition to Mycophenolate Mofetil PO
Role of NSAIDs w/lupus?
tx arthralgias
Pt with neck pain in the morning that last for about 2 hrs along with knee, wrist and general joint pain. Dx? Tx?
Rheumatoid arthritis
Tx: NSAIDs(supplemental) + DMARDs(methotrexate > leflunomide, hydroxychlorquine if prego) +biological(anti-TNF if severe) + steroids(flares)
Tx of severe RA?
NSAIDs(supplemental) + DMARDs(methotrexate > leflunomide, hydroxychlorquine if prego) +biological(anti-TNF if severe) + steroids(flares)
Tx of RA flare?
NSAIDs(supplemental) + DMARDs(methotrexate > leflunomide, hydroxychlorquine if prego) +biological(anti-TNF if severe) + steroids(flares)
How to dx RA?
- Anti-RF(sensitive) & CCP(specific)
- Symmetric arthritis that involves three joints and spares the DIPs
- X-ray shows Periarticular osteopenia and marginal bony erosions
- Rheumatoid nodule biopsy shows cholesterol deposits
What is the pathology of RA?
Auto immune disease resulting in pannus formation at the joint which leads to a erosion and bony destruction
What would you see if you biopsied a rheumatoid nodule?
Cholesterol deposits
What is the classic presentation of RA?
How long morning stiffness affecting many small joints that is symmetric. Morning stiffness last longer than 60 minutes and if it doesn’t go off the back will only affect the cervical spine. (Lower back=ankylosing spondylitis)
Ai dx resulting in collagen replacing smooth muscle?
Scleroderma
CREST scleroderma?
Calcinosis, Reynards, esophageal dysmotility, sclerodactyly, telangiectasias.
Assoc w/anti centromere an.
Systemic scleroderma dx?
CREST + heart + renal
Assoc w/anti scl70
How do you treat scleroderma?
Treat symptoms! Use calcium channel blocker’s for Reynards. Penicillamine for skin changes. Ace inhibitors for hypertension. And steroids for acute flare’s
Pathology of Sjögren’s syndrome
Inflammation of. Exocrine glands do to lymphoplasmacytic infiltrate
Symptoms of Sjogren’s
Dry eyes, dry mouth, bilateral parotid gland enlargement. Associated with ro and la antibodies
How do you treat Sjogren’s syndrome
Symptom control with artificial tears and saliva
Symptoms of polymyositis, dermatomyositis, inclusion body myositis
Painful proximal muscle weakness, heliotropic rash, photosensitivity, Groton’s papules
How do you test for myositis?
You do EMG=electromyography to differentiate it from peripheral neuropathy
Treatment of myositis and associated antibodies
Steroids!!! Jo and Mi
Pt w/ 1 swollen joint. <50 wbcs and no gram stain on tap. Dx?
Crystal dz
+birefringent crystals, rhomboid shape w/ calcium pyrophosphate. Dx? Tx?
NSAIDs or Colchine
-birefringent crystals, needle shaped, mono sodium irate, podagra. Dx? To?
Gout!
If due to:
1. Tumor lysis syndrome: PPx: IVF + probenecid + allopurinol Tx: rasburicase
- Decrease excretion(diuretics,age,etoh,ckd) Tx: NSAIDS or Colchicine if no change add steroids +dirt &if refract allopurinol
Hot tender, swollen join w/ >50 WBCs and somthing on gram stain dx?
Septic joint!
Pt w/ >50 WBCs one joint tap w/ gram+cocci in clusters. Dx? Tx?
Staph! Usually due to trauma, IVDA or endocarditis
To: vanc vs nafcillin
Pt w/ >50 WBCs one joint tap w/ gram-cocci in chains, urethritis, cerivicitis, tenosynovial rash. Dx? Tx?
Gonorrhea! To: ceftriax and doxy(chlam)
HLA B27 associated spondyoarthropathies
PAIR = Psoriatic Arthritis, Ankylosing Spondylitis, IBD-Assoc Arthritis, Reactive Arthritis
pt w/urethrits who now has asymmetric bilateral arthritis of the lower back and hands and conjunctivits. dx? tx?
Reactive Arthritis = usually do to chalymidia
tx: cause! = doxy + NSAIDs
27 yo dude w/lower back pain + morning stiffness that improves w/use. +stiffness in his right ankle. dx? assoc? tx?
Ankylosing Spondylitis = men 20-30 w/calcifications of joints + tendons(achilies mc) = bamboo spine on xray.
- associated w/UC
- inflammation at ligamentous insertions
tx: NSAIDs > Methotrexate > Etanercept(TNF inhib)
Pt w/IBD and now has arthritis in his back. You treat the patient for his IBD and arthritis goes away. dx?
IBD-associated arthritis/Enteropathic
*may also involve other joints!
Pt w/IBD and now has arthritis in his back. You treat the patient for his IBD and arthritis doesnt goes away. dx?
Ankylosing Spondylitis! the person prob has UC!
